Second-Generation Antipsychotics as Adjunctive Therapy for Depression

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ACE Impact subscribers, and welcome to the Game Changers Critical Update Podcast.
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I'm your host, Rachel Maynard, and today we're going to be talking about the role of atypical antipsychotics, also called second generation antipsychotics, in managing depression.
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This is coming up because an atypical antipsychotic Lubiteperone was recently approved as an add-on therapy along with antidepressants for the treatment of major depressive disorder in adults.
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And it joins other atypicals, including erophyprazole, frespifazole, and type and extended release, as antipsychotics that are approved as adjunctive therapy for depression.
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But this recent approval made a bit of a splash in headlines, and it raises questions about when lumatibrone should be considered as an add-on for depression, as well as when second generation antipsychotics fit in more broadly for depression.
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So to help us dig into this topic, I'm very excited to introduce our guest today, Dr.
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Sarah Grady.
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So welcome, Sarah.
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Morning, Rachel.
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Thank you.
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We're so happy to have you.
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I know you've got a very busy schedule, so really appreciate you taking the time to chat with us today.
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And for our listeners who haven't heard your voice on the podcast in the past and you've been on before, could you share a little bit about your background, your current role, and why you're interested in this topic?
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Yes, thanks again.
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My name is Sarah Grady.
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I'm a professor of pharmacy practice at Drake University College of Pharmacy and Health Sciences.
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I'm also a clinical pharmacist on the Inpatient Behavioral Health Unit at Broadlands Medical Center.
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So I assist in the care of many patients that have depression, mild, moderate, severe, as well as difficult to treat depression.
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So very interested in this topic.
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Excellent.
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Yes, it sounds like you'll have a lot of great practical experience to share with our listeners today.
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So let's just start out by talking about Lumiteperone, which is this recently approved drug for as an adjunct to major depressive disorder.
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So if we could just have an overview of what lumiteperone is and what it was previously approved for and how it works, that would be great, I think, to help level set us, get us on the same page.
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Yeah, so lumiteperone has been out since approximately 2019.
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It was originally FDA approved for schizophrenia.
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Since then, it's achieved FDA approval, or I should say acquired FDA approval for bipolar one and two.
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And most recently in November, as you stated, it received the adjunctive adjunctive agent for depression approval.
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How it differs a little bit from the other second-generation antipsychotics with regards to its mechanism.
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There are a few ways in which it differs.
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The first way is that very strong 5-HT2A antagonist.
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Obviously, the other antipsychotics have that mechanism as well, but this is very, very strong, quite strong.
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It also has serotonin reuptake inhibition properties.
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So this may give it some antidepressant effects that differ a little bit from the other second-generation antipsychotics.
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Many second generation antipsychotics also have antidepressant properties, but none really have a great deal of serotonin reuptake inhibition.
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So this is a difference in mechanism.
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How will this translate clinically?
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We obviously know it's got the FDA approval, but how will it work for the individual person?
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It's going to probably work for some people.
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It's not going to work for everybody, but we will see what happens.
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I feel like in the management of depression, we need every single tool and agent and technique available.
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So this just adds to our tools, and it might be appropriate for some people, but it may not be appropriate for everybody.
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I think you've highlighted a really important point that will come up probably again multiple times in our discussion.
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But thank you for the summary and also for sort of tying in how the mechanism may potentially theoretically have benefit for depression to that serotonin, how did you describe it?
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Serotonin and serotonergic.
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Yeah, serotonin reuptake inhibition.
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Right.
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So again, as we think about our SSRIs, similar sort of potential benefit there.
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Again, strictly through mechanism of action, how that will play out clinically may yet be seen, but that actually transitions nicely into this new approval for limoteperone in the as an adjunct for depression.
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And so maybe you can talk a little bit about some of the clinical studies that were used to get that approval and how what what kinds of data we have so far.
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Yeah, so the clinical trials again showed some very some good results looking at the uh primary outcome measures, a reduction on the madras.
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The madras is the kind of one of the gold standards that we use for scoring depression, and it did show improvement compared to placebo.
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And the the trial was set up in a similar fashion to some of the other second-generation antipsychotics that currently have FDA approval.
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So, again, some good measures that they looked at.
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They had rather strict inclusion-exclusion criteria, which is typical for a trial such as this one.
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So, again, the the trials look beneficial, but we will have to see how this works out clinically in practice.
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Yeah.
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Okay, I'm glad you reiterated that because as you say, real-world data can sometimes look different than these trials, which are often very short.
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I think these were no more than a few weeks of duration.
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So how that will play out longer term is always sort of yet to be seen.
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And you mentioned it was studied versus placebo, but just to be clear, versus placebo, but in patients already on antidepressants, is that correct?
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Correct.
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They were already on, because this is an adjunctive trial.
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So they were already on antidepressant therapy.
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And as you mentioned, these are acute trials, you know, so six, four, six, eight weeks in duration, and also a couple hundred patients in each uh treatment group.
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So I think it's important to keep that in mind because that's why we'll need to see how this plays out clinically.
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Right, absolutely.
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Okay, great summary there.
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So we've got that foundation with lumiteperone.
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Let's talk about second generations, second generation antipsychotics more broadly and their role as adjunctive therapy for depression, because not everyone with depression needs a second generation antipsychotic.
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So, what what really is the broader role outside of lumiteperone specifically for these second-generation antipsychotics in managing depression?
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Absolutely.
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They are geared mainly toward individuals that have a partial response to a traditional antidepressant.
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Okay, and so I can define what a response is.
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A response is a 50% reduction in baseline symptoms.
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A partial response would be a 25 to 49.99% reduction in symptoms.
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Okay, so these are really geared towards people that have that partial response mainly.
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This is what they are geared towards.
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And again, the evidence is there that they can be helpful for that partial response.
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But I want to make it clear that there are also other options that can be helpful for a partial response.
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And clinical practice guidelines highlight these options available for partial response.
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Obviously, they include the second generation antipsychotics, but you can also consider psychotherapy if you're not already doing that.
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And there are other agents that have been studied for partial response.
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There, they may not be necessarily listed high-ranking and treatment guidelines, but we can look at them.
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These include agents such as lithium, abuse pyrone, you know, we have thyroid hormone supplementation.
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So there are lots of ways that you can manage partial response according to treatment guidelines.
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Another thing you can do first and foremost is we want to, and we can do this as pharmacists, we want to see are they taking, you know, whenever a patient tells me my antidepressant isn't working, I ask them kind of the obvious questions.
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Are you trying to take it every day?
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Is your dose high enough?
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Um, has your duration been long enough?
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All those things matter.
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And especially if somebody thinks the antidepressant, the traditional antidepressant, might be helping them, we might want to look at increasing the dose.
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And, you know, we want to stay within the FDA recommended range.
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But, you know, for example, if they're taking Sertuline, 100 milligrams, and they're seeing a little bit, they're seeing a pressure response, they're feeling a little bit better.
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Maybe we can see if they can tolerate a higher dose, you know, and so maybe look at dose optimization, um, considering all our options for pressure response.
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Obviously, that includes our um, you know, our second generation antipsychotics, but we have other medications that we can look at too.
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You called up too many important things.
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Yeah, go ahead.
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Sorry.
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My apologies.
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We just the point is we have a lot of options.
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And yes, second generation antipsychotics, they have the FDA approval, and we want to consider them, but we have lots of other routes we can go if somebody doesn't feel comfortable starting one of them for whatever reason, you know.
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So lots of options available, which is a good thing.
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Yeah, absolutely.
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And and like you alluded to with the approval of lumiteprone, it is another tool in the toolbox.
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And I think that that also resonates here, where we have lots of tools in the toolbox more broadly in terms of how how patients can be managed, not necessarily going to a second gender recent antipsychotic or even this specific drug per se.
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So, but yeah, you brought up so many important points there.
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I just want to reiterate a few of them.
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The idea of partial response and evaluating that.
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And one thing that comes to mind is the idea of giving the anti traditional antidepressant, as you said, at the optimized dose for enough time.
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So what as you said, that's a really important part for pharmacists to be looking for.
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So um what is the dose?
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Is it optimized?
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And then how long?
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Because it takes time to titrate too.
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And so how do you consider all of that?
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If a patient is starting out on an antidepressant, a traditional antidepressant, how do you ensure what what kind of time frame are you waiting for them to get to that optimized dose?
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And then how long should they expect it to take for the antidepressant to kick in at the optimized dose?
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What is what is that sort of time frame that you're looking for generally?
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Yeah, it's a it's a on average, it's it's lengthy.
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Yeah.
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And that is difficult for for everybody.
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It's, you know, when when when you know folks have depression, not feeling well, wanted to feel better yesterday, they can really take these medications, um, you know, several weeks really.
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Um, most of our medical literature states that it can take, you know, uh a full six to eight weeks or longer to see full therapeutic benefit.
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And it has again, we need to we need to factor in titration, um, you know, and so yes, like I said, really six to eight weeks or longer to to see a therapeutic benefit.
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Um, that's an average.
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It will there will be some individual variation, like there always is.
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And that's another reason why it makes you know mental health management a bit challenging, you know, from time to time.
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But again, pharmacists were perfectly uh positioned to kind of reiterate these concepts along with adherence, taking the medication every single day.
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I think the other thing that kind of compounds traditional antidepressant treatment is that on average, different symptoms will start to improve at different times.
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So we we always like to say that the physical symptoms of depression, sleep disturbances, appetite disturbances, low energy, those symptoms may start to improve before the emotional symptoms of depression.
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You know, the emotional symptoms, depression, the sad mood, the loss of interest and activities one normally finds enjoyable, the suicidal ideation, you know.
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So physical symptoms of depression may start to improve before emotional symptoms of depression.
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And, you know, that's one of the reasons why we have, you know, the black box warning, because particularly in younger people, this can happen to anybody, but energy may improve before the emotional symptoms.
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And so this can be problematic.
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So we have lots of factors, I guess, going on with traditional antidepressants.
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But yes, really, if you look at the the trials among the antidepressants, the traditional antidepressants, you know, those are six-week trials, typically eight-week trials, and and there's a reason for that.
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Yeah, yeah.
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I think that's uh such an important point to drive home because as you said, pharmacists educating about this, helping patients have realistic expectations when they're starting.
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So I think it's great you called out physical symptoms result or improving before emotional symptoms, but just the length of time this can take generally and supporting them through that titration and with adherence, as you said, even if you're not feeling full benefit, continue on to see if you're going to get that response.
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So you mentioned anti-psych the antipsychotics as an adjunct for patients with partial remission or partial response, I should say.
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When would you think about switching to a different traditional antidepressant versus then adding the antipsychotic or another adjunct?
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But what do you think about switching versus adding?
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Yeah, great question.
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I can think of a couple scenarios.
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Number number one being, so I talked previously about response, you know, 50% reduction from baseline symptoms, pressure response 25 to 49.99% reduction in symptoms.
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Non-response is considered less than 25% reduction in symptoms.
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So certainly when somebody has non-response to an agent, and again, we have to factor in are they taking it every day as prescribed?
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Is the dose high enough?
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Is the duration long enough?
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So we have to factor in those three.
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Also, if they're having side effects that are bothersome to them.
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I think in a lot of cases, depends on the person, but you know, some people uh uh understandably feel so terrible with the sad mood and the other symptoms of depression that they may be willing to tolerate maybe some dry mouth or you know, maybe some of the other the stomach upset, some of the other um antidepressant side effects that are commonly seen.
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But you know, let's say they develop a side effect that it's just too bothersome to them and it makes them feel even worse, you know, than they already do, then you know, that would be another scenario where we wouldn't want people to be on the drug.
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Okay.
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And when thinking about antipsychotics specifically in the menu of other options that you have as an adjunct and considering some of the pros and cons with antipsychotics broadly, how does that factor into your decision-making process with the patient?
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Yeah, uh front of mine.
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I feel as though there is always, I don't want to say always, but there is usually a risk versus benefit discussion.
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So we know the benefit of some of these second generation antipsychotics that have FDA approval for this.
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The data is out there.
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Data is out there, so we we know the benefits.
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Um, what we need to discuss, especially as pharmacists, are the risks and mainly the risks of long-term use of second-generation antipsychotics.
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So we need to be talking with patients about the risk of what I call or what we call drug-induced movement disorders, uh, formally known as EPS.
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Okay, so risk of tartar dyskinesia, although the risk of TD is low with the second generation antipsychotics, it's not zero.
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So whenever I am speaking to or with a patient about an antipsychotic, I don't care what it is, I don't care what the purpose is.
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Take apiprazole, for example.
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I would say in my setting, its most common use is an adjunctive agent for depression.
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So we have many patients that are on aeropirazole for that purpose and they're on low doses.
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Um, and I'm always letting them know about the risk of taryskinesia with long-term use.
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Low risk, very low risk, but not zero risk.
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And again, pharmacists in any setting can certainly talk to patients about that.
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Metabolic risks.
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Um, so the agents, most of the agents, with the exception of quatiapine, most of these agents are gonna have a lower risk of weight gain and hyperglycemia and dyslipidemia, but again, may not be zero.
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So I'm always encouraging patients that are taking an antipsychotic and they're gonna be using it long term.
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We want to be monitoring that.
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And some of these agents, certainly not all of them, you know, we can sometimes have some increased prolactin levels.
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Again, this is going to be less of a factor with the second generation antipsychotics that we have FDA approval for for this purpose.
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But like I said, I I really think that pharmacists in every single setting that, you know, if we're if we're taking care of folks that are taking um antipsychotics for any purpose, we do want to let them know about an ongoing conversations about the risk of uh drug-induced movement disorders, metabolic side effects, and depending on the antipsychotic, the risk of hyperprolactinemia.
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Absolutely.
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Those are definitely important safety considerations to be educating patients about, and also again, thinking about those in the risk-benefit analysis when you're considering what options are available for patients who've had a partial response.
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So considering all those, does that do atypical second generation antipsychotics still provide a where do they sort of rank in terms of the options where you might think about next steps for a patient with a partial response to a traditional antidepressant?
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How does it sort of stack up?
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Yeah, great question again.
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This is where I like to look at our treatment guidelines.
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And in the last couple of years, the the more recent treatment guidelines have definitely put second generation antipsychotics in the conversation for looking at them as an adjunctive agent.
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But I want to underscore they're not the only agents that have been moved up in the algorithm, if you will.
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Um, another option that has moved up in treatment guidelines is psychotherapy.
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You know, so again, I want to underscore, yes, they are they are an option.
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They are a good option for some people, not everybody.
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You know, I always I feel like in my practice settings, uh, particularly I'll I'll use Arab Hippers as an example, just because we are at this time at my institution it using it the most out of the other FDA-approved agents, uh, probably because it's had this indication the longest, right?
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And we're familiar with it, but we are really watching to see if it works or not.
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We are really watching to see if the patient is comfortable with it.
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Many of our patients are, but not all of them.
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You know, in the case of uh Airpipperzole, we we see a lot of side effects of acadesia, feeling restless.
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And particularly when we have someone that has depression, they have loss of interest, suicidal thoughts, we don't want them feeling restless.
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So we are very intentional and deliberate in watching, you know, is it working for the patient?
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And if it's not working, we transition them off of it.
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The again, that risk versus benefit.
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Yeah, and shared clinical decision making, having those conversations up front with the patient, helping them wait through the options and then.
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As the patient is starting and continuing tolerability, evaluating, reevaluating.
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So, all part of that standard patient care process.
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I love that you called that out.
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I think what you have been highlighting in your practice is a great opportunity to sort of segue into the role of Luma Taperon, since that was our hook for this discussion and why we're sort of talking about this more broadly.
00:22:21.680 --> 00:22:28.559
Where do you think it's going to fit in compared to other second generation psychotics in this role as adjunct therapy for depression?
00:22:28.799 --> 00:22:31.039
How does how does it sort of compare or stack up?
00:22:31.759 --> 00:22:32.079
Sure.
00:22:32.240 --> 00:22:32.640
Yeah.
00:22:32.880 --> 00:22:35.440
And I'm still, it's a newer agent, right?
00:22:35.519 --> 00:22:44.480
So I'm like everyone else, I'm still learning about it and I'm still thinking about how it fits in or what differentiates it more importantly.
00:22:44.640 --> 00:22:52.799
Again, the first thing that comes to mind is it does seem to have a different mechanism than the others.
00:22:52.960 --> 00:22:58.960
And again, so that might play a role, I guess, in in two regards.
00:22:59.200 --> 00:23:08.480
One could be yes, it for some people, it may really provide that additional antidepressant property, which is what we're looking for.
00:23:08.720 --> 00:23:21.039
But the other thing, Rachel, that I've been thinking about, because this is where my trained as a pharmacist, I'm always thinking actually safety first because it has serotonin reuptake and ambition.
00:23:21.759 --> 00:23:21.920
Yeah.
00:23:22.319 --> 00:23:28.880
Will that put us at greater risk for serotonin syndrome with some of our SSRIs and SNRIs?
00:23:29.200 --> 00:23:34.480
And I noticed that, you know, that is mentioned in the medical literature a little bit.
00:23:34.640 --> 00:23:38.000
The clinical trials didn't pick that up.
00:23:38.160 --> 00:23:40.720
But again, they were short duration, right?
00:23:40.799 --> 00:23:45.200
Um, you know, and hundreds of patients, you know, versus thousands.
00:23:45.359 --> 00:23:52.880
So I feel like pharmacists, especially, in fact, you know, I had a physician call me a couple weeks ago.
00:23:53.039 --> 00:23:57.599
You know, they saw the new indication and they said, We, you know, what do you what do you think?
00:23:57.759 --> 00:23:59.599
I read the trials, just like you did.
00:23:59.759 --> 00:24:01.519
Yes, it can be helpful.
00:24:01.920 --> 00:24:03.599
Stats look decent.
00:24:04.079 --> 00:24:12.799
Yes, we're we gotta factor in not a long duration, a couple of hundreds, a couple hundred patients versus a couple thousands.
00:24:12.960 --> 00:24:14.319
We got to factor all that in.
00:24:14.480 --> 00:24:19.759
And I said, I said, yeah, you know, on paper, it it looks good and obviously has FDA approval.
00:24:19.920 --> 00:24:24.400
But what I don't know about is will we have a risk of serotonin syndrome?
00:24:24.640 --> 00:24:25.279
I don't know.
00:24:25.759 --> 00:24:29.440
I don't know, you know, but I I put that, I just mentioned that to the physician.
00:24:29.519 --> 00:24:34.720
They're like, yeah, yeah, I gotta monitor for that, and let's let the let's let the patient know about that.
00:24:34.799 --> 00:24:35.039
Yeah.
00:24:35.200 --> 00:24:42.240
So that's probably you know a safety mechanism for for we as pharmacists to think about.
00:24:42.559 --> 00:24:51.759
The other thing that we've been seeing, so we have been using, you know, the the the new agent, newer agent for this indication.
00:24:51.920 --> 00:24:54.720
We have been using it at our practice, but not for this purpose.
00:24:54.880 --> 00:24:58.720
We've been using it for schizophrenia, we've been using it for bipolar.
00:24:59.440 --> 00:25:06.640
We are seeing varies per person, but we are seeing from a side effect profile some you know, some sedation.
00:25:06.799 --> 00:25:09.920
Um so we've been using it at bedtime.
00:25:10.079 --> 00:25:17.680
So this may um factor in to folks that they have the type of depression where they just can't sleep, right?
00:25:17.920 --> 00:25:19.039
They can't sleep well.
00:25:19.519 --> 00:25:25.839
Even the maybe the traditional antidepressant has helped the insomnia a little bit, but they're still not sleeping well.
00:25:26.079 --> 00:25:33.119
So maybe lamentaporone would um you know provide some additional sedation for them.
00:25:33.279 --> 00:25:41.920
So sedation we are seeing, we're seeing some dry mouth, we're seeing some nausea again, and I think uh the nausea is probably from the serotonin reuptake and ambition.
00:25:42.319 --> 00:25:44.799
So, you know, those are just some things to factor in.
00:25:44.880 --> 00:26:02.880
So to summarize, we'll see how it plays out, but just on paper, it looks like the mechanism might be may add something to what's already out there from both an effectiveness standpoint as well as a safety standpoint.
00:26:03.200 --> 00:26:08.559
Again, I'm I'm hoping for the effectiveness standpoint, and certainly that's what we've seen in the clinical trials.
00:26:08.960 --> 00:26:17.279
But we've talked about the potential limitations of our trials, and as pharmacists, we will be conducting further post-marketing surveillance.
00:26:17.839 --> 00:26:18.160
Sure.
00:26:19.920 --> 00:26:26.319
That's a great summary, and I that ties into a lot of the counseling points we'd want to be thinking about with patients starting this too.
00:26:26.559 --> 00:26:43.039
And I love how you brought together that serotonergic effect could be providing some benefit in this specific indication, but also could be introducing some risk in this indication because these patients are also going to be on traditional antidepressants, often, which have serotonergic effects.
00:26:43.119 --> 00:26:45.839
And so, yeah, that's a very good consideration.
00:26:45.920 --> 00:27:06.160
And then when you think about serotonergic considerations and other meds that can then add to that burden and sort of tip a patient over potentially, having that on your radar is really important because I don't know that I would necessarily think of a second generation antipsychotic as having a serotonin, you know, potentially contributing to that to that burden.
00:27:06.319 --> 00:27:08.400
So really important point to call out there.
00:27:08.640 --> 00:27:11.599
And the sedation also is an interesting consideration.
00:27:11.759 --> 00:27:16.799
As you said, if a patient's struggling with insomnia, this may have potential benefit there for some patients.
00:27:16.880 --> 00:27:18.559
As you said, it's so patient-specific, right?
00:27:18.640 --> 00:27:23.599
And we really need to think about the individual patient and what's going to be beneficial or not for them.
00:27:23.680 --> 00:27:25.599
But yeah, it's yeah.
00:27:26.000 --> 00:27:33.359
And Rachel, I bring that distinction up just because, again, we are most familiar at my setting with aeriprizole.
00:27:33.519 --> 00:27:33.920
Right, yeah.
00:27:34.799 --> 00:27:45.839
And aripazole, it varies per person, but aeropiprazole, especially at the lower doses that we use for depression adjunct, it can activate people, it can energize people.
00:27:46.079 --> 00:27:46.400
Right.
00:27:46.640 --> 00:27:48.880
So we usually give it in the morning.
00:27:49.039 --> 00:27:56.079
Yes, there's always a few people, it makes tired, but that you know, that is a kind of a differentiating factor, I think.
00:27:56.160 --> 00:28:00.640
And and earlier in the podcast, we talked about, you know, cotiopine.
00:28:00.799 --> 00:28:21.200
Obviously, cotiopine can be sedating, but I think it's good to have a mixture of things that can maybe add to some energy or maybe help with sleep symptom-wise, because the sleep can can be an issue, whether it's insomnia or hypersomnia.
00:28:22.799 --> 00:28:37.759
So, in terms of any other practical or practical considerations or counseling points that you want people to know about with lumitoporon, the other thing that's coming to my mind is cost because Eric Piperzole, as you said, has been around for years, has had that indication for years, is generic.
00:28:37.920 --> 00:28:39.279
This is not going to be a generic.
00:28:39.680 --> 00:28:46.720
Any other considerations that our listeners should be aware of when thinking about this sort of new introduction into this indication?
00:28:48.160 --> 00:28:55.359
I'm thinking, and yeah, thank you, of course, for mentioning the cost factor, because we have to factor that into the risk versus benefit.
00:28:55.519 --> 00:29:10.000
But um, but yeah, again, the the difference in mechanism, I think pharmacists want to highlight, which can be a positive thing, which we saw in the studies, um, but again, may contribute to that serotonin burden.
00:29:10.079 --> 00:29:11.839
So we want to probably think about that.
00:29:11.920 --> 00:29:27.680
And of course, the mentioning the long-term potential adverse effects with antipsychotics in general, the drug-induced movement disorders, especially tardiviskinesia, metabolic risk, and risk of hyperprolactinemia with some of the agents.
00:29:28.799 --> 00:29:33.279
Good counseling points to keep in mind with the second generation antipsychotics in general.
00:29:33.599 --> 00:29:38.000
We talked about the sort of onset effect for traditional antidepressants.
00:29:38.079 --> 00:29:45.279
How long would you tell a patient to expect to see onset of effect for an adjunct antipsychotic in general?
00:29:46.400 --> 00:29:48.480
Yes, excellent question.
00:29:48.799 --> 00:29:59.680
And we expect to start to see some improvement in, I guess, those residual symptoms of depression really by by two weeks.
00:30:00.079 --> 00:30:01.359
We should start to see something.
00:30:01.839 --> 00:30:08.880
Um, not full benefit, but we should see improvement in something by two weeks.
00:30:09.039 --> 00:30:20.640
Um, depending on the agent when used for this purpose, they we might start to see some earlier results compared to traditional antidepressants.
00:30:21.039 --> 00:30:26.559
I would say certainly at one month out, we would want to see improvement.
00:30:26.720 --> 00:30:33.440
And if we're not seeing improvement, then we're going to have conversations about do we leave this on a little bit longer?
00:30:33.680 --> 00:30:35.680
If so, how much longer?
00:30:36.000 --> 00:30:39.839
Um, because again, risk versus benefit.
00:30:40.000 --> 00:30:45.519
I always, this is just my personal opinion, and I always share this with patients.
00:30:45.759 --> 00:31:01.680
It is my personal opinion, but if you know, with the potential long-term side effects of antipsychotics, if they are not helpful, we don't want to be taking them, and we want to look at other options for um augmentation.
00:31:01.920 --> 00:31:22.079
And as we stated throughout the podcast, we have other options that can be helpful, optimizing the dose, switching the antidepressant, adding on therapy, adding on, you know, you know, and even we didn't speak about this, but you know, even maybe adding on another antidepressant to a traditional antidepressant.
00:31:22.160 --> 00:31:23.200
There's data for that.
00:31:23.440 --> 00:31:31.039
So, yes, and again, this is this is where pharmacists in any setting can be uh instrumental, you know.
00:31:31.279 --> 00:31:48.160
Let's say there's someone coming to your pharmacy to pick it up their second month of their second generation antipsychotic for their depression augmentation, particularly if you know that patient well, you know, we would start to we expect to see some benefit by now.
00:31:48.240 --> 00:31:50.160
We expect to see something.
00:31:50.559 --> 00:32:00.160
Um again, we want to verify adherence because maybe they're showing up at your pharmacy five or six weeks after they're starting it.
00:32:00.400 --> 00:32:05.279
And if they're not taking it every day as prescribed, it it's not gonna work.
00:32:05.359 --> 00:32:08.799
Uh, we're not gonna get the best effectiveness from the medication.
00:32:09.119 --> 00:32:09.599
Right.
00:32:09.839 --> 00:32:21.680
Well, I love how you're reiterating the point out of adherence and the crucial role for pharmacists because often we do have visibility into when that refill is coming up, and that is right about the time frame when we would be hoping to see response.
00:32:21.759 --> 00:32:30.160
So good, great time to check in, have that conversation around tolerability, but also efficacy and and how the patient's doing overall, and then reevaluating.
00:32:30.319 --> 00:32:34.160
Because as you said, this doesn't have to be this isn't our only option.
00:32:34.319 --> 00:32:35.359
We have lots of options.
00:32:35.519 --> 00:32:37.839
So I think that's a great point to tie that all together.
00:32:38.000 --> 00:32:47.599
And I thank you for also speaking to how long we expect to see that benefit because I think that's a consideration that we should be thinking about when we're seeing those patients at the check-in.
00:32:47.839 --> 00:32:49.920
So we're about out of time for today.
00:32:50.079 --> 00:32:56.240
So it is our game changers podcast, and we do want to wrap up with a game changer and what you want our listeners to walk away with today.
00:32:56.319 --> 00:32:58.720
So, what would you say is the game changer, Sarah?
00:32:59.599 --> 00:33:16.559
I'd say the biggest game changer is we have another tool in our toolbox in in our our fight against this condition that impacts many people all over the world.
00:33:16.640 --> 00:33:22.880
Um, it may impact us, it may impact our family, our friends, our colleagues.
00:33:23.200 --> 00:33:29.519
So, yes, like anything else, it's not a perfect option, but it's another option.
00:33:29.680 --> 00:33:35.119
And it's an option that can maybe help some of our patients.
00:33:35.200 --> 00:33:36.799
It's not going to help all our patients.
00:33:36.880 --> 00:33:44.720
It's not the right option for all our patients, but a game changer is we have another option in our toolbox.
00:33:45.359 --> 00:33:46.480
Excellent summary.
00:33:46.720 --> 00:33:53.839
Another tool in the toolbox is a great takeaway, and also waiting and seeing how it pans out in the real world.
00:33:53.920 --> 00:33:57.440
We'll we'll have to wait and see and maybe check back in a couple of years.
00:33:57.759 --> 00:34:00.000
Yes, we're gonna cross our fingers.
00:34:00.160 --> 00:34:01.440
That's right, that's right.
00:34:01.599 --> 00:34:02.079
Excellent.
00:34:02.240 --> 00:34:03.680
Well, thank you so so much, Sarah.
00:34:03.839 --> 00:34:06.160
Really appreciate your time and your expertise on this topic.
00:34:06.720 --> 00:34:07.599
Thank you, Rachel.
00:34:07.680 --> 00:34:08.639
You have a good day.
00:34:08.880 --> 00:34:09.760
Thank you.
00:34:10.239 --> 00:34:16.000
So, listeners, be sure to claim your CE credit for this episode of Game Changers by logging in at CEimpact.com.
00:34:16.159 --> 00:34:18.480
And as always, have a great week and keep learning.
00:34:18.559 --> 00:34:21.840
I can't wait to dig into another game changing topic with you all next week.